The Chiswick Nursing Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

The last rating for this key question was good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of legal regulation in relation to involving people to manage risk, safe and effective staffing and the ways people’s medicines were managed.

We identified a breach of regulation 12 relating to safe care and treatment . We found recording of care plan and risk assessment information was inaccurate.

We identified a breach of regulation 18 relating to staffing. We found staff were rushed when providing care above healthcare requirements due to the high level of people’s healthcare needs.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. The provider processes were not always followed to enable learning from incidents where people may have been put at risk. People said staff did listen to concerns about safety, but they were not always investigated. Staff said whilst the management team, listened to concerns about safety they were not always acted upon. This meant lessons were not always learnt to continually identify and embed good practice.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. The staff shifts were 12 hours. Staff told us that this did not include provision time for handover. The impact of this was handover of any safety concerns was dependent on the good will of staff either coming on shift early unpaid or leaving late.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. The provider had efficient safeguarding policies, procedures, and processes that followed current, relevant legislation. The systems demonstrated safety concerns were reported to the registered manager, recorded, frequently monitored, and raised with appropriate bodies in a timely way. As appropriate, people and those important to them were involved in this process and informed about what action would be taken to keep people safe. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. A relative said, “Quite happy for [Person using the service] to be here. He is safe.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The information contained in people’s care plans and risk assessments did not always correspond. A person’s care plan recorded pressure ulcers on their toes, whilst the risk assessment recorded pressure ulcers on their heel. This was on the same date. Another person’s care plan recorded repositioning required every 3-4 hours. The risk assessment recorded, skin integrity repositioning every 2-4 hours. This would be important to reduce the risk of pressure sores and promote skin integrity. The Repositioning Chart recorded on repositioning at 19.12pm and 21.54pm only. A staff member confirmed this corresponded with the daily entry record and there was no further information. The staff member confirmed nurses were responsible for reviewing the care charts. There was no evidence this was completed or addressed. We found positional changes for other people were mostly completed at the required times. However, we did find several examples where this had not been completed in line with their assessed needs. A nurse explained sometimes the repositioning of people coincided with personal care needs and therefore were included in other areas of their care plans. A person’s care plan communication section identified “Risk of Miscommunication.” The detail stated, “English language effective communication, good hearing, and eyesight, has capacity.” A staff member confirmed the person was able to understand and be understood. In addition, the care plan recorded - cannot use call bell but under “Actions” it recorded “Please place the call bell in proper position at my reach.” A staff member said Service User C did use a call bell. The impact of this was people could receive inappropriate care and support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The care home provided a very clean environment for people to live and staff to work in. People did not directly comment regarding the care home being a safe environment, although they did say it was very clean.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. Whilst there were enough staff to meet people’s healthcare needs this was the priority and meant that their social needs were not met very well. This was particularly in relation to people who spent a lot of time in bed and in their rooms. Most people and their relatives said whilst the staff were kind and caring, they were unable to spend much with people above meeting their healthcare needs. A relative told us, “I’m quite happy for [Person using the service] to be here. The staff are good workers and nice, although time limited and task driven as there aren’t enough of them.” Another relative said, “The care is amazing, and mum gets the care she needs, but she is limited in what she can do as there are not enough staff.” Many staff we spoke with also echoed this. A staff member said, “I love my job and the people and want to spend more time with them, but we just don’t have it.” The staff recruitment process was thorough, and records demonstrated it was followed, and reviewed. Staff received training based on the Skills for Care 'Common induction standards. They form part of the Care Certificate which is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social sectors. Whilst the training recorded was comprehensive, some of the care practices observed particularly regarding dementia did not correspond to recognised good practice. It was hard to discern if this was due to not understanding the training or lack of time to put it into operation. Staff were seen “feeding” people whilst standing over them rather than sitting with them and this limited people’s access to social interaction. One member of staff was “feeding” a person whilst walking with them. They explained that the person did not stop walking, although they did stop occasionally and these opportunities could have been used better. Two staff fed people their main meal before the soup starter. Other people were given their starter, main and dessert at the same time. Three people ate their meals whilst sat in the reception area, next to the main entrance door, rather than in the dining area, lounge or their bedroom. The impact of this was that people’s social needs on some floors were not met.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The building was clean throughout no malodours. Audits were recorded with scores for each floor. One person told us, “[The care home] Always kept clean.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. The provider’s medicines processes were not always followed by staff, accurately recorded, and audited. One person using the service had their medicine administered in a way that was contrary to that recorded in their Medication Administration Record (MAR) sheet. Two members of staff could not explain why they were administering medicine differently to the prescribed directions on the MAR sheet. This was rectified by staff after it was pointed out by the inspector. A manager told us a medicines audit by the home should take place monthly. They then said the last audit had taken place in October 2024. This had not been picked up by the provider’s organisational audits. The impact of this was people were at risk of not receiving the correct medicine as prescribed.